Provider Demographics
NPI:1881871051
Name:GISMONDI, REGINA (APRN,BC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GISMONDI
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MARLBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:W COLLS HGTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08059-1922
Mailing Address - Country:US
Mailing Address - Phone:856-349-2425
Mailing Address - Fax:
Practice Address - Street 1:1015 WALNUT ST
Practice Address - Street 2:604 CURTIS BUILDING- DEPARTMENT OF SURGERY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-955-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009635363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care